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Wednesday, 28 May 2003
Page: 15246

Mr ORGAN (5:43 PM) —The government would have us believe that the Health Care (Appropriation) Amendment Bill 2003 delivers on its commitment to the principle of universality under Medicare. However, the government's proposed changes to bulk-billing show just how shallow that claim is. These changes reveal that the government is hell-bent on destroying universality by creating a two-tier system of access to bulk-billing for general practitioner services, forcing more of the cost of health care onto the sick, families and low-income earners.

Medicare is one of the pillars of Australia's public health care system. Its goal is to guarantee access to quality, affordable health care for all those who need it, irrespective of income. However, the government has a plan that undermines the philosophy that underpins Medicare. The government's Medicare package, announced last month, will lead to a reduction in public funding for health care and an increase in private expenditure. The chief beneficiaries will be private health insurance companies, who stand to profit from the so-called safety net for out-of-hospital expenses above $1,000 a year, and doctors who choose not to bulk-bill patients. This is because the government's plan will allow doctors to claim the patient's rebate directly while still charging a copayment or additional fee. The fee a patient pays will appear lower than the fees charged currently, which range from an additional $12 to $20 per consultation, but the direct claiming of the patient's rebate removes an important restraint on the size of the copayment. Health economists have warned that this will make it easier for GPs to increase the size of the copayment over time.

Medicare is not perfect, but it is too valuable to lose. Our national public health insurance scheme has largely succeeded in its goal of making sure that people get treatment based on need, not ability to pay. The progressive decline in bulk-billing rates for GP services under this government is an indication of the problems that are eroding the principle of affordable access based on need. The Howard government has allowed the value of the rebate to decline over time, so many doctors find it difficult to bulk-bill most patients and meet the costs of running a practice. The government also imposed caps on Medicare provider numbers, creating problems of insufficient doctors eligible to provide services covered by Medicare.

The government's package acknowledges the work force problems that its own policy created. The Greens support the work force measures in the April package, but the problems will take many years to overcome. The fact is that the Prime Minister has never liked Medicare and has been particularly hostile towards bulk-billing. He campaigned against Medicare until the 1996 election, when he realised Australians would never vote for a party that threatened to dismantle the scheme. Now he wants to do just that.

The government's proposal to pay a higher rebate to GPs who bulk-bill concessionary patients from $1 in capital cities to $6.30 in rural and remote areas is aimed at trying to shore up the falling bulk-billing rate. It is certainly not about fairness. Self-funded retirees earning up to $50,000 a year will qualify as concessionary patients, but families earning as little as $35,000 a year will not. These relatively poor families will be forced to pay up-front for a visit to the doctor, and the government is forcing them to join private funds. Neither the Prime Minister nor the health minister has been prepared to state that the current health care package will lift bulk-billing rates. That is because they know it will not and, what is more, they are not committed to increasing the rate.

The Medicare package is more evidence of the government's free market ideology. The government would prefer to give every Australian a pittance in income tax cuts—around $4 a week for average income earners—rather than invest the surplus in the services people want their governments to provide: health and education. Opinion polling shortly after the Treasurer delivered his budget speech this month confirmed what the Greens called for: investing the surplus in public goods that benefit all Australians.

The government's approach to Medicare is not even good economics. The Medicare proposals will lead to less efficient use of public funds. The United States, where 40 million people do not have private insurance, spends 14 per cent of gross domestic product on health compared to Australia's eight per cent. The federal government already spends almost $2.3 billion a year to subsidise private health insurance. This will rise under the government's plan. This money is being stolen from the public health care system. Australians should not have to buy private health insurance. Australians deserve a strong, well-funded, reliable public health care system.

The Greens advocate scrapping the wasteful $2.3 billion private health insurance rebate and redirecting these funds into public health. This money could be used to increase the GP rebate immediately by $5. This represents a 20 per cent increase which would go a long way to enabling more doctors to bulk-bill and which would cost no more than $500 million a year. The Greens believe that Australians do not want an Americanised health care system but instead value the effective and fair system that Medicare can be. This system needs defending and extending to cover dental health and more mental health services.

This bill exemplifies the government's ideology. It provides for $42 billion over five years to the states and territories through the Australian health care agreements. This money pays for public hospitals and other public health services provided by the states and territories. The government has delayed the negotiation of this next five-year agreement. In the final months, it has bullied the states and territories, and now it seeks to cut almost $1 billion out of the forward estimates for the agreements. It is doing so on the basis that private hospitals are treating more patients and so this has relieved pressure on public hospitals. There is, of course, no evidence to support this contention. Our public hospitals remain underresourced, understaffed and overstretched, in part because people who cannot find a doctor who bulk-bills are turning to public hospitals for treatment.

The fundamental principle of Medicare is universal access to health care. A core component of this is free, universal access to public hospital services. Not only is the federal government determined to create a two-tier system of health care in this country with regard to visiting GPs; it has become increasingly clear that it wishes to do the same with our hospitals. The wealthy get one standard of hospital treatment, which they can afford to pay for, while the rest of us get treatment at public hospitals. Ultimately, the government wants private hospitals to provide a higher quality of care so that people will be increasingly attracted towards paying for private treatment. The government may well claim that it is committed to universal access, and indeed universal access may continue. But will universal quality health care continue?

Although public hospitals are largely the responsibility of state governments, under Medicare the federal government makes a substantial financial commitment to them. It is clear that across the nation our public hospitals are in crisis. A genuine and combined effort by the federal and the state governments is required to address this crisis, but this begs the question: is the government really all that interested in addressing this increasing crisis? The government claims that by introducing its private health insurance reforms it has contributed to a better balance between the public and private hospital systems, but the reality is that the winners in this sleight of hand trick are the owners of private hospitals. The cost of a procedure in a private hospital is often more than the same procedure in a public hospital. The government boasts that pressure on public hospitals has been reduced. Anyone who can afford it is getting elective surgery done in the private sector because of the massive waiting list they face in the public sector. Anyone who cannot afford it waits and waits and waits.

Why is this? It is because private hospitals exist to make profit for their owners and shareholders. They are businesses, and businesses exist to make profit to give shareholders a return on their investment. Investment in public hospitals, however, is a direct investment in health care. Saying that public hospital admissions have fallen while private hospital admissions have risen is nothing to be proud of, unless standards of care have risen for the same expenditure. This government is back to its old tricks of enriching the private sector at public expense. How else can you explain the fact that a government is refusing a licence for an MRI machine at Wollongong Hospital—a public hospital—while licensing a nearby private operator? Try telling the people of the Illawarra that there is any increase in the standard of care from that decision. They will tell you, as will the public hospital system health professionals, that it just makes access to a vital diagnostic tool more difficult. And what about the private health insurance rebate that the government claims has contributed to this alleged better balance between the public and private hospitals? The $2.3 billion that could, and should, be invested directly in health care is being siphoned off to prop up private health funds, which are still increasing their premiums. Who benefits from that? Which sick child is better off because private health funds are benefiting from the public purse?

One thing is certain: the states do not believe they will be better off under this bill. It is all very well for the government to blithely claim its commitment to health care is transparent and unprecedented while saying the states' contribution is far less apparent, but what is the reality? The government says the states will be $2.5 billion better off under the arrangements proposed in the bill, but there has been a decrease of a billion dollars in what was anticipated. It is not surprising that the states have not signed up, is it? The states also claim that there has been no great change in the number of admissions to public hospitals, despite the fact that there has been a substantial increase in private hospital admissions. The states have so far refused to sign any new agreement, arguing that public hospitals need a much higher injection of funding. There is no agreement on the next round of Australian health care agreements because the states have seen through the government's sleight of hand.

Australia's public health care system deserves more than the government's threats and fudged figures. The government needs to deliver on what is one of their core responsibilities to the people of Australia: universal access to quality public health care. The government's attempts to dodge this responsibility and to pretend they have a commitment to Medicare whilst they continue in vain to bully states into substandard agreements are simply selling short the people they were elected to serve on what they deserve. If it were not for the fact that public hospitals would be further starved of funds by rejection of this bill, I would vote against it. It is deeply flawed and undermines health care in the public system. The Greens are committed to ensuring the principle that underpins Medicare—that is, access for all, based on need, not income—is given full meaning. We will continue to strongly defend Medicare against this government's attempts to dismantle it by stealth and we will work to make Medicare better.